Seasonal variations of the dexamethasone suppression test in depression compared with schizophrenia: a gender effect.

The circannual results of the dexamethasone suppression test (DST) were compared in depressed and schizophrenic patients for the periods November-February and March-October. During the winter months, female depressive and schizophrenic patients had lower rates of DST nonsuppression as well as lower concentrations of post-dexamethasone plasma cortisol, compared to the March-October period, despite similar pre-dexamethasone cortisol levels. Male depressed patients had lower pre-dexamethasone cortisol levels during the winter months while male schizophrenics had higher pre- and post-dexamethasone cortisol levels and higher rates of DST nonsuppression. This may suggest less disturbance of HPA axis function in winter months in depressed patients, mostly females, and confirms findings from some previous studies. A gender effect of DST seasonality was also demonstrated, with male schizophrenic patients presenting a reverse DST nonsuppression pattern compared with female depressive and female schizophrenic patients.     

单胺氧化酶A基因多态性与精神分裂症的关联研究

目的探讨河南地区汉族人群单胺氧化酶A（monoamine oxidase A，MAOA）基因多态性与精神分裂症的关系。方法参照CCMD-3诊断标准，选取212例精神分裂症患者与168名正常对照，应用聚合酶链反应及限制性片段长度多态性技术检测MAOA基因多态性，采用病例一对照的关联分析方法对精神分裂症患者及正常对照的基因型和等位基因频率进行分析。结果（1）MAOA基因的基因型在患者组和对照组中均符合Hardy-Weinberg平衡定律（X^2=0．618，dr：2，P〉0、05；X^2=3．173，df=2，P〉0．05）。（2）MAOA基因的基因型和等位基因频率在患者组与对照组间的分布差异无统计学意义（P〉0．05）。（3）按性别分组，男性患者组中CT基因型分布频率显著高于男性对照组（X^2=7．654，P=0．022）。（4）MAOA基因的基因型和等位基因频率在家族史阴、阳性间的分布差异无统计学意义（P〉0．05）。结论没有发现MAOA基因多态性与汉族精神分裂症的发病有关联，但对性别发病有影响，基因型CT可能是男性精神分裂症发病的易感因素。     

Does power matter with ECT?

BACKGROUND: To assess the incidence of depressed inpatients requiring high output ECT and the response of this group compared with a group requiring standard output ECT. METHODS: We reviewed the records of 59 consecutive inpatients that were treated with bilateral ECT between January 2001 and January 2004. Diagnosis of major depression was based on DSM IV criteria. Response and remission to ECT (respectively defined as a 50% reduction in score and a score of < or = 7 on the Hamilton Rating Scale for Depression; HRSD) of both groups were compared. RESULTS: Of the 59 patients, 13 (22%) required high output ECT. These patients needed significantly more ECT treatments than patients in the standard dose group (16.4+/-7.1 versus 10.4+/-4.5; p=0.01). In total, 31 of 46 patients (67%) requiring standard output ECT and 11 of the 13 patients (85%) requiring high output ECT responded to ECT. This difference is not significant. LIMITATIONS: This study has a retrospective nature and a rather homogenous sample. CONCLUSION: In this study 1 in 5 of the depressed inpatients needs a high dose energy of bilateral ECT to induce an adequate seizure. The efficacy of ECT in these patients is similar to that in the standard dose group. Considering these facts, high output ECT devices should be available for use in routine clinical practice.     

Gender differences in premorbid social adjustment and intimacy motivation in schizophrenia

The present study compared the relationship between motivation for intimacy and level of premorbid adjustment for men and women with schizophrenia. A sample of 34 schizophrenic patients (14 male and 20 female) were studied. Stories told in response to six TAT cards were scored for Intimacy Motivation (IM). Levels of Premorbid adjustment (PA) and Asociality (ASOC) were assessed. A statistically significant interaction between gender and level of PA indicated that males with good PA had higher IM than those with poorer whereas females with good PA had lower IM than females with poor PA. The same interaction was obtained for the measure of ASOC. Findings are discussed in relation to sociocultural expectations for women. Some implications for differential treatment needs of male and female schizophrenics are suggested. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 35–48, 1998.     

Effect of SOX10 gene polymorphism on early onset schizophrenia in Chinese Han population

Schizophrenia is one of highly heritable psychiatric disorders. Patients with early onset schizophrenia tend to have a greater genetic loading and may be an attractive subpopulation for genetics studies. A single nucleotide polymorphism (SNP) rs139887 in sex-determining region Y-box 10 (SOX10), a candidate gene for schizophrenia, was suggested to be associated with schizophrenia although inconsistent results had been reported. The aim of this study was to evaluate the association between SOX10 rs139887 polymorphism and schizophrenia using an early onset sample in the Chinese Han population. A total of 321 schizophrenic patients with onset before age 18 and 400 healthy controls were recruited for association study. In addition, two populations involved in three studies were selected for meta-analysis to determine the effect of rs139887 on schizophrenia. Our association study results showed that the allele and genotype frequencies were significantly different between schizophrenic patients and controls (P=0.013 and P=0.034, respectively). Interestingly, a significant association in allele and genotype frequencies were found in male patients (P=0.017 and P=0.045, respectively), but not female patients. Moreover, the C/C genotype had a significant association with an earlier age of onset in male schizophrenic patients (Kaplan-Meier log-rank test P=0.029), but not in female patients (Kaplan-Meier log-rank test P=0.876). The meta-analysis result showed the same C allele was significantly associated with schizophrenia (P=0.007). In conclusion, the SOX10 rs139887 polymorphism was related to the development of schizophrenia in a gender-specific manner, and may be a significant genetic marker for managing subgroups and etiological clues in schizophrenia.     

Gender‐specific molecular heterosis of dopamine D2 receptor gene (DRD2) for smoking in schizophrenia

We examined the genetic effect of DRD2 A1 allele in 167 Korean schizophrenics in relation to their smoking habit. Although there was no apparent difference in the genotype distributions of DRD2 gene among the female schizophrenics (n = 66), the male counterpart (n = 101) showed significant differences in their genotype distributions. The comparison between male smoking and non‐smoking patients showed the difference in genotype distribution (P = 0.010) with a higher prevalence of A1 allele (P = 0.020) and frequency of heterozygotes (P = 0.005), but not frequency of the A1 allele. The A1A2 heterozygotes male showed significantly higher smoking rate compared to the A1A1 or A2A2 homozygotes male, and non‐smokers were deficient in heterozygotes. By contrast, among female schizophrenics, the heterozygotes showed a lower smoking rate than homozygotes and there were more heterozygotes in non‐smokers. The deviation from Hardy‐Weinberg expectations was observed in male and female non‐smokers showing quite opposite profiles. Highly significant differences were seen between male and female non‐smokers in A1 prevalence (P = 0.001), genotype distribution (P = 0.00011), and frequency of heterozygotes (P = 0.00003), but not in A1 frequency. The analyses from both male and female as one group showing no significant difference in the genotype distributions between smokers and non‐smokers could be explained by the gender difference in the genetic effect of DRD2 A1 allele. Our findings present the gender‐specific molecular heterosis of DRD2 gene in relation specifically to the smoking status of schizophrenic patients. They indicate the importance of heterosis and gender effects that should be taken into consideration for the association studies. © 2002 Wiley‐Liss, Inc.     

Frontal lobe in vivo (31)P-MRS reveals gender differences in healthy controls, not in schizophrenics

Phosphorus-31 magnetic resonance spectroscopy ((31)P-MRS) has gained much interest in schizophrenia research in recent years since it allows the non-invasive measurement of high-energy phosphates and phospholipids in vivo. However, until now only differences in metabolite concentrations between certain brain areas of schizophrenic patients and healthy controls have been examined. We investigated the influence of gender on the concentrations of different phosphorus compounds. For this purpose, well-defined volumes in the frontal lobe of 32 healthy controls and 51 schizophrenic in-patients were examined with an image selected in vivo spectroscopy (ISIS) sequence on a whole-body scanner at 1.5 T. Healthy females exhibited increased values of inorganic phosphate (P(i)) and decreased values of phosphocreatine (PCr) in comparison to their male counterparts. In schizophrenic patients such gender differences were not present. Thus, the results can be interpreted in the sense that frontal energy demanding processes are enhanced in female compared to male healthy volunteers; schizophrenia seems to reduce these gender differences.     

不同性别首发精神分裂症患者听觉事件相关电位的研究

目的 研究不同性别首发精神分裂症患者听觉事件相关电位(ERP)是否存在差异,并分别探讨两组事件相关电位与临床阴性、阳性症状的关系.方法 对60例(男32例,女28例)首发神分裂症患者及30例正常人进行事件相关电位检测,并运用阳性和阴性症状量表进行精神症状评定.结果 ①两患者组的N2、P3潜伏期明显长于对照组,P3波幅明...     

Toxocara seroprevalence in schizophrenic patients in Turkey

PURPOSE: To investigate the seroprevalence of toxocariasis in patients diagnosed as schizophrenia. PATIENTS AND METHODS: Ninety-eight schizophrenic patients hospitalized at The Elazig Psychiatric Hospital were included in the study. Anti-Toxocara IgG and/or IgM antibodies were determined by using commercial Toxocara canis IgG and/or IgM ELISA kit. RESULTS: Seropositivity for T. canis was detected in 45 (45.9%) of 98 patients and 2 (2.0%) of 100 control subjects the difference was statistically significant (p<0.001). The seroprevalence was 40.4% (19 cases) and 51.0% (26 cases) for female and male subjects, respectively (p=0.3). When the seropositive and seronegative schizophrenic patients were compared with respect to the age group environment they were living in, occupation period of follow up and number of hospitalizations, there were no differences between the two groups (all, p>0.05). CONCLUSION: In conclusion, the schizophrenic state seems to present a high risk for Toxocara infection in Turkey.     

精神分裂症患者临床特点的性别差异

目的比较男性及女性精神分裂症住院病人的起病年龄、症状、病程演变特点等指标的差异。方法于2006年对177例精神分裂症患者进行回顾性研究,其中男性88例,女性89例。对男女两组的有关情况进行比较。结果与男性相比,女性患者具有如下倾向：文化程度较低,妄想较少见,情感不协调较多见,治疗剂量较少,疗效较差。结论男性及女性精神分裂症患者在文化程度、症状特点及病程转归等多方面均存在显著差异,提示在制定治疗方案时,应有所区别。     

精神分裂症白质损害与发病年龄的弥散张量成像研究

目的:应用弥散张量成像(DTI)比较精神分裂症患者脑白质与正常人群间的差异,并探究各向异性比值(FA)的改变与发病年龄之间的相关性。方法:纳入27例精神分裂症患者和29名性别、年龄及受教育程度相匹配的健康对照。两组研究对象均接受头颅磁共振检测。患者组按照发病年龄分为早发组(发病年龄18岁)和成年发病组(发病年龄≥18岁)。采用基于体素的分析方法,分别比较患者组和对照组、早发组和成年发病组之间FA值的差异,并在控制性别、病程和药物剂量影响的前提下,分析FA值与患者发病年龄的相关性。结果:与健康对照比较,患者组在右侧上纵束、右侧放射冠上部的FA值降低;患者组中早发组和成年发病组间FA值的差异无显著性。患者组FA值与发病年龄呈正相关的脑区包括右侧放射冠前部(r=0.70,P0.01)、右侧胼胝体膝部(r=0.65,P0.01);未发现呈负相关的脑区。结论:本研究提示精神分裂症患者右侧脑区上纵束及放射冠部位存在白质损害,发病年龄愈早,右侧放射冠及胼胝体膝部白质纤维的受损愈重。这对精神分裂症病理生理改变及脑结构异常的进一步研究具有提示作用。     

Influence of resistance to antidepressant pharmacotherapy on short-term response to electroconvulsive therapy

BACKGROUND: Few studies assessing the influence of resistance to antidepressant pharmacotherapy on the response to subsequent electroconvulsive therapy (ECT) are found in the literature. Results are somewhat conflicting and may not be applicable to the population of depressed patients in The Netherlands. The aim of this study is to assess the influence of medication resistance on the short-term response to ECT in a population of severely depressed inpatients in The Netherlands, where ECT is an exceptional treatment, often used as a final treatment option. METHODS: We reviewed the records of 41 consecutive inpatients with major depression according to DSM-III-R criteria and rated each patients' antidepressant pharmacotherapy prior to ECT. We examined the extent to which medication resistance was related to short-term response to ECT. RESULTS: When a reduction of at least 50% on the Hamilton Rating Scale for Depression (HRSD) post-ECT compared to pre-ECT (partial remission) is used as response criterion, medication resistant patients and patients without established medication resistance were equally likely to respond to subsequent ECT. When a post-ECT HRSD score < or = 7 (full remission) is used as response criterion, medication resistant patients were less likely to respond to subsequent ECT (8/29=27.6%) than patients who did not receive adequate antidepressant pharmacotherapy prior to ECT (6/12=50.0%), although the difference in response rate was not statistically significant. LIMITATIONS: This study has a retrospective nature and a relatively small sample size. CONCLUSION: Antidepressant medication resistance does not seem to have an influence on the short-term response to subsequent ECT. However, when the number of patients achieving full remission is concerned, a substantial percentage of antidepressant medication resistant patients respond to ECT, although their response rate was nearly half compared to that of patients without prior adequate treatment with antidepressants. This difference in response rate was not statistically significant. ECT seems to be an effective treatment for both patients with and without prior adequate treatment with antidepressants in this Dutch population.     

抑郁症患者威斯康星卡片分类测验和连续操作测验的初步研究

目的 :通过与精神分裂症患者和正常对照的比较 ,探讨抑郁症患者的执行功能和注意功能。方法 :采用威斯康星卡片分类测验 (WCST)、连续操作测验 (CPT) ,对 66例精神分裂症患者、 42例抑郁症患者和 5 0名对照者的执行功能和注意功能进行评估。结果 :两组患者WCST中的总测验次数、持续错误数和随机错误数均明显多于对照组 (P <0 0 1) ;其中精神分裂症组WCST的三项成绩明显差于抑郁症组 (P <0 0 1) ;无干扰刺激时 ,精神分裂症组的认对数明显差于抑郁症组和对照组 (P <0 0 1) ,而抑郁症组与对照组之间的差异无显著性 (P >0 0 5 ) ;有干扰刺激时 ,精神分裂症组与对照组的差异有显著性 (P <0 0 1) ,抑郁症组与其它两组的差异均无显著性 (P >0 0 5 )。结论 :抑郁症组有执行功能障碍 ,介于精神分裂症组和对照组之间 ;在抑郁症组中没有发现有明显的注意障碍。     

Gender Difference in the Prodromal Symptoms of First-episode Schizophrenia

To investigate the gender difference of early symptoms appearing before the onset of the psychotic symptoms in patients with first-episode schizophrenia, we reviewed the medical records of 63 patients (38 males, 25 females), who were hospitalized for first-episode schizophrenia. The frequency and duration of prodromal and psychotic symptoms, Clinical Global Impression scale scores, Global Assessment of Functioning (GAF) scale scores at admission, and other clinical characteristics were recorded for all patients. Overall, the most common prodromal symptoms were attenuated positive symptoms (89%), followed by mood symptoms (86%). Negative symptoms were the most common in male patients (97.4%), whereas attenuated positive symptoms were the most common in female patients (84%). Male patients demonstrated more frequent negative, cognitive, and obsessive-compulsive symptoms than female patients did and also showed a tendency of having negative symptoms for the longer period. Correlational analysis showed a significant negative correlation between the duration of negative symptoms and GAF scores at admission in male patients. Our findings suggest that different patterns of prodromal symptoms between male and female begin before the onset of the psychosis. Further prospective studies should be needed.     

CAG repeat expansions and schizophrenia: association with disease in females and with early age-at-onset

An increase in the severity of schizophrenia through consecutivegenerations (anticipation) has been found in some studies offamilies with affected members. Anticipation in five neurologlcaidisorders is known to arise from the expansion of CAG repeatsbetween generations of affected individuais. The ‘repeatexpansion detection’ method was used to screen indlviduaigenomes for the size of such expansions in a sampie of schizophrenicand normai sub jects. Comparison of the frequency distributionof CAG expansions observed in schizophrenic patients to thatfor normal subjects, showed that there are significantly moreexpansions in patients (p = 0.048). When male and female subjectsare considered separateiy, there is a highly significant differencein the distribution of repeat sizes found between affected andnormal females (p = 0.0023) but no significant difference betweenaffected and normal males. Over all there is a 28% excess ofexpansions observed in affected versus normal females, and theirpresence confers a relative risk of 4.12 (p <0.005). in contrast,the frequency distribution of age-at-onset with respect to repeatsize is nearly the same in male and female patients and, whenthe sexes are combined, the larger (CAG)^69–136 expansionsare associated with a younger age-at-onset (p = 0.02).     

Gender differences in bipolar affective disorder

We report a study of gender differences in a sample of 111 manic patients. Female manics (N = 78) exhibited fewer manic and more depressive symptoms than males (N = 33). Although male manics had a more frequent history of delayed landmarks, the two groups did not differ in cortical function as measured by EEG and neuropsychological testing. There were no significant differences between male and female relatives of male and female probands for unipolar or bipolar affective disorder, alcoholism or sociopathy. Female relatives of both groups were at greater risk for total affective disorder and male relatives were at greater risk for alcoholism. Familial illness patterns indicated that male and female manics shared the same genetic liability for affective disorder and that X-linked transmission was unlikely.     

舒必利治疗首发精神分裂症的性别差异

目的 了解抗精神病药物对男女精神分裂症患者是否存在性别差异。方法 对71例首发精神分裂症患者以不同性别进行分组,应用舒必利治疗,以阳性症状和阴性症状量表（PANSS）、副反应量表（TESS）评定疗效及不良反应,在治疗前及治疗后第1、2、4、6、8周末各评定1次。结果 两组患者治疗后与治疗前的PANSS评分比较差异有显著性（P〈0．05或P〈0．01）,男性平均用药剂量大于女性平均用药剂量,有显著性差异（P=-0．034〈0．05）。结论 首发精神分裂症患者男女用药剂量不一样,女性患者平均用药剂量较小。     

Is gender a factor in psychiatrists' evaluation and treatment of patients with major depression?

BACKGROUND: Gender differences in clinical assessment and treatment have been reported in several areas of medicine. We examine whether differences exist in the routine outpatient psychiatric management of men and women with major depression. METHODS: Psychiatrists practicing in the community completed case forms on a systematic sample of their adult outpatients with major depression. Comparisons are presented between male (n=261) and female (n=472) patients focusing on their background characteristics, clinical presentation, assessment, and treatment. Significant gender disparities in assessment and treatment are also examined with respect to the gender of the treating psychiatrist. RESULTS: Although male and female patients had generally similar clinical profiles, a significantly greater proportion of males than females had psychomotor retardation and substance use disorders. No significant gender differences were observed in the assessment of depressive symptoms, psychiatric comorbidities, and treatment with antidepressant medications or psychotherapy. However, a significantly smaller percentage of depressed women than men received assessments of sexual function and medication-related sexual side effects. Female patients were also less likely to have discussed their treatment preferences with their psychiatrists. LIMITATIONS: Only a minority (33.2%) of psychiatrists invited to participate contributed patients to this study. The results are based on structured assessments completed by practicing psychiatrists rather than patient self-assessments or independent research assessments. CONCLUSIONS: Although we find overall little evidence of gender bias in the clinical management of major depression, both male and female psychiatrists need to further explore sexual function and treatment preferences in female patients.     

A clinical and epidemiological survey of parasuicide and suicide in Edinburgh schizophrenics

Between 1968 and 1981 there were roughly equal numbers of male and female schizophrenic parasuicides in Edinburgh: males were significantly younger than females at parasuicide (33 v. 37 years), and had received a diagnosis of schizophrenia for a shorter time (3.4 v. 7.2 years). The clinical, epidemiological and social characteristics of such parasuicides are, by and large, those that might be expected from a knowledge of the epidemiology of schizophrenia. Eight per cent of a sample of Edinburgh schizophrenic first-ever parasuicides subsequently committed suicide, when followed up for up to 14 years. This percentage is close to what would be expected for later suicide in non-schizophrenic parasuicides. When all the suicides were considered, similar numbers of male and female schizophrenics killed themselves; their mean ages at death were 42 and 43 years respectively; and the mean duration of the schizophrenic illness was 10 years in both cases, according to hospital records. We found slight evidence that parasuicide is commoner in schizophrenic suicides than in schizophrenic controls but little evidence to support the contention that there may be a specific relationship between suicide (or parasuicide) and the presence of auditory hallucinations, recent discharge from in-patient care, the use of depot neuroleptic medication, or recent parasuicide. From the point of view of the prevention of suicide and parasuicide in schizophrenics, it is noteworthy that we found few differences between the clinical characteristics and management of schizophrenic parasuicides and suicides, and schizophrenic controls.